Prueba de esfuerzo cardiopulmonar en pacientes con insuficiencia cardíaca crónica: comparación con sujetos normales y reproductibilidad de las mediciones / Cardiopulmonary exertion test in patients with chronic cardiac failure: comparison with normal people and reproducibility of measurements

The aim of this work was to measure oxygen consumption and carbon dioxide production during exercise in 21 subjects with cardiac failure and 13 normal subjects. During the resting period, subjects with cardiac failure had higher ventilatory frequency and respiratory quotient than normals. During maximal exercise, the former achieved higher ventilatory frequency and oxygen ventilatory equivalent than normals. In subjects with cardiac failure and normals, anerobic thresholds were 14,4ñ0,9 and 28,8ñ2,2 ml/kg/min respectively and peak oxygen consumptions 17,1ñ1 and 34,4ñ1,7 ml/kg/min respectively. There were less than 10 percent differences in parameters when tests were repeated in 10 subjects with cardiac failure. It is concluded that gas exchange testing may be a reliable and objective assessment method in patients with cardiac failure

Pepsanurina en la insuficiencia cardíaca congestiva / Pepsanurin in congestive heart failure

We have identified a plasmatic substance, "pepsanurin" (PU) obtained by pepsin hydrolysis which inhibits the renal effects of the atrial natriuretic factor (ANF). To investigate whether patients with congestive heart failure (CHF) have increased plasma levels of PU we prepared PU from 10 patients with CHF class IV (NYHA), 9 patients with CHF class II or III and 16 healthy controls. Anesthetized rats were used to test the effects of ANF, 0.5 ug/100 g body weight i.v., before and following the intraperitoneal injection of 0.5 ml of PU. The inhibition of the diuretic and natriuretic effects of ANF was 40.9 ñ 11.9% and 49.8 ñ 12% respectively for control subjects. Corresponding figures for clas CHF patients were 62.3 ñ 3.1% and 73.8 ñ 3.5% (p < 0.02) and for class II-III patients 39.2 ñ 7.0% and 53.1 ñ 8.2% (NS). Accordingly, an increased capacity to generate PU may underlie the decreased sensitivity to ANF in patients with advanced CHF

Terapía combinada de propranolol y diltiazem en angina crónica de esfuerzo / Combined therapy with propranolol and diltiazem in with chronic exertional angina

The effects of diltiazem, 240 mg/day, were studied in 12 p atients with chronic exertional angina and angiographically proven coronary artery disease, who received maintenance therapy with propranolol. Mean age was 60,1 years (range 46 to 67). Patients received propranolol, 60 to 240 mg/day, before and during the study. A double blind, placebo contorlled, cross-over design was used to test the effect of added diltiazem, durign 8 weeks. Duration fo execise varied from 398 ñ 30 (mean ñ SEM) to 419 ñ 37 (placebo) or 469 ñ 35 sec (diltiazem) (NS). Time to appearance of angina veried from 283 ñ 32 to 313 ñ 34 and 302 - 27 sec, respectively (NS). Resting and maximal effort heart rate and blood pressure did not differ among basal, placebo and iltiazem conditions. Segmental wall motion analysis by radioisotopic ventriculogram revealed diskynetic zones during placebo rodiltiazem therapy. Basal ejection fraction did not increase during exercise and this was not modified by diltiazem or placebo. Thus, the addition of diltiazem to propanolol in patients with chronic, exertional angina failed to modify angina threshold, exercise duration or left ventricular performance